RSV-Related Healthcare Burden: A Prospective Observational Study in a Resource-Constrained Setting

Abstract

AbstractBackgroundRespiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations globally, impacting overstretched health systems. Comprehensive data is vital for informing RSV vaccination policies.MethodsFrom January to December 2019, a prospective study was conducted at Bangladesh’s largest pediatric hospital to evaluate RSV’s burden on the health system. We analyzed hospitalization rates, lengths of stay, and outcomes for children under five using WHO criteria and qPCR testing. We also examined survival probability for children denied admission due to bed shortages, compared with those admitted using the Kaplan-Meier method, and estimated the effects of a maternal vaccine using Monte-Carlo simulations.FindingsOut of 40,664 children admitted, 31,692 were under five. Of these, 19,940 were eligible for study inclusion with 7,191 meeting inclusion criteria; 6,149 (86%) had samples taken, with 1,261 (21%) testing positive for RSV. The hospital incidence rate was 465 per 10,000 admissions. The median age of RSV patients was 3 months, with a median stay of 5 days. RSV accounted for 8,274 bed days of the total 151,110 observed bed days. In-hospital mortality was 1.9%, increasing to 9.9% during a 90-day follow-up over telephone. Additionally, 9,169 children were denied admission during the study period; of these, 5,969 under-five children were approached, and outcomes of 2,850 admitted versus 3,928 refused were followed. The hazard ratio for death was 1.37 for refused versus admitted children, highest within neonates at 1.7. A 70% efficacious vaccine would equate to adding 50 hospital beds and averting 195 deaths.InterpretationRSV significantly contributes to pediatric hospitalizations in Bangladesh, exacerbating healthcare burdens and increasing mortality risks. Maternal vaccination could significantly reduce both direct and indirect RSV burdens, enhancing healthcare capacity and benefiting overall child health in resource-limited settings.FundingBill and Melinda Gates Foundation